Provider Demographics
NPI:1104126473
Name:ABEYTA, JOLENE KATHY
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:KATHY
Last Name:ABEYTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 WALTER ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-4658
Mailing Address - Country:US
Mailing Address - Phone:505-842-8182
Mailing Address - Fax:505-842-8173
Practice Address - Street 1:1500 WALTER ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4658
Practice Address - Country:US
Practice Address - Phone:505-842-8182
Practice Address - Fax:505-842-8173
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator